Root canal treatment in Skopje

What root canal treatment is and what it can do

Root canal treatment (endodontics) removes an inflamed or infected nerve from inside a tooth. You may also hear ‘root filling’, ‘having the nerve taken out’ or ‘killing the nerve’. If you are considering root canal treatment in Skopje, here is what it involves.

The ‘nerve’ is really the pulp: the soft core of the tooth, with its nerves and blood vessels. Once it is removed, the canals are cleaned, disinfected and sealed, and the tooth is restored with a filling or a crown (cap). A fully developed tooth can function without its pulp, as the tissues around the root keep nourishing it.

• You can keep your natural tooth instead of having it out.
• The source of the pain and infection is removed, to stop the infection spreading into the bone.
• With a permanent filling or crown, you can chew on the tooth again.

Do you need root canal treatment?

The nerve can become inflamed or infected because of deep decay, a cracked tooth, a knock, a leaking old filling, repeated treatment on the same tooth or gum disease. Possible signs include:

• severe pain when you bite or chew
• sensitivity to hot or cold that lingers
• a gum boil (a pus-filled spot on the gum), or swelling of the gum, face or jaw
• a tooth that has darkened
• pain that spreads to your jaw or face

Signs alone are not enough: a diagnosis needs an examination, tests and an X-ray. Sometimes an infection that causes hardly any pain is found only on an X-ray.

If you are in severe pain, read what to do until your appointment or check whether a same-day appointment is available during opening hours.

When a tooth cannot be saved

A tooth usually cannot be saved if it is severely broken down, has broken below the gum line or has a vertical root fracture, or if too little bone is left around it. The alternative is then taking the tooth out and replacing it with a bridge, a denture or an implant.

Very curved or narrowed canals take longer to treat, and some cases need referral to a root canal specialist (an endodontist).

What to tell us before treatment

Please tell us which medicines you take, and whether you are pregnant, have a heart condition or diabetes, take long-term steroids (corticosteroids) or medicines for your bones (bisphosphonates, denosumab), or smoke. This helps us plan your treatment safely.

What happens during root canal treatment, step by step

1. Examination and X-ray. The tooth is tested and X-rayed to show the roots and any infection.
2. Local anaesthetic. You stay awake, and a feeling of pressure is normal.
3. Removing the nerve. The inflamed or infected tissue is removed through a small opening in the tooth. Any abscess is drained.
4. Cleaning and disinfecting. The canals are cleaned, rinsed with antibacterial solutions and shaped.
5. Medicine and a temporary filling. If another visit is needed, medicine is placed in the canals and the tooth is temporarily sealed.
6. Filling the canals. The canals are filled with gutta-percha (a rubbery material) and a sealing paste.
7. Permanent filling or crown. This is usually placed at a separate visit, with a post in the canal if needed.

Visits and timing: how long does a root canal take?

Back teeth (molars) have more canals, so treatment usually takes longer. Do not put off the permanent filling or crown: a temporary filling can leak or break, and a delayed crown is a recognised cause of failure.

Anaesthesia and pain: what you will feel

The treatment is done under local anaesthetic, and most people say it feels similar to having a filling. A very inflamed tooth is sometimes harder to numb. If you still feel pain, tell us: more anaesthetic can usually be given.

The numbness lasts about two to four hours. Do not eat until it wears off.

If you are nervous about the dentist, tell us when you book and read what to expect at your first visit.

Recovery and care after a root canal

Most people go back to work the same day. Mild pain after a root canal is common and usually settles within a few days to a week, sometimes up to two weeks.

• Eat softer foods for a few days, and do not bite hard on the tooth until it has its permanent filling or crown.
• For pain, take paracetamol or ibuprofen as directed, unless a doctor has advised otherwise.
• Brush after meals and clean between your teeth every day.
• Avoid smoking, as it can slow healing.
• Take antibiotics only if prescribed, and exactly as directed.
• Come back for the permanent filling or crown and for check-ups.

Call us if the pain is severe or throbbing, gets worse or lasts more than a week, if swelling develops, or if the temporary filling falls out. Outside our opening hours, contact the public out-of-hours dental service.

Risks, limitations and alternatives

• Pain or swelling after treatment or between visits, sometimes needing an extra appointment.
• Reinfection, sometimes months or years later, for example from a missed canal, a delayed crown, a leaking filling or new decay. The options are then retreatment (redoing the root canal), surgery at the root tip (an apicectomy) or extraction.
• Tooth fracture, especially in a back tooth without a crown. A vertical root fracture usually means extraction.
• Complications in difficult canals, such as a perforation (a hole in the root wall) or a broken instrument.
• Side effects of the anaesthetic, such as bruising or temporary tingling. Serious reactions are very rare.

In a review of several studies, 86–93% of treated teeth were still in place 2 to 10 years later. This is not a promise for any individual tooth: the outcome depends on the tooth, how it is restored and how it is cared for.

What are the alternatives to root canal treatment?

Leaving an infected tooth untreated is not a safe option: infection can lead to an abscess, swelling and bone damage.

How much does a root canal cost, and what affects the price?

• Which tooth. Molars have more canals than front teeth.
• How complex the case is. Curved or extra canals, an abscess, the number of visits.
• First treatment or retreatment. Retreatment means removing the old root filling, and sometimes a post.
• X-rays for diagnosis and follow-up.
• The permanent filling or crown, usually priced separately and a significant part of the total.

After your examination, and before treatment begins, you will receive a written plan with the cost. Pricing is explained on our prices page. If Dr Kiril Milanovski is your chosen dentist (izbran stomatolog) under the Health Insurance Fund (FZO), we will explain what the Fund covers and what you pay privately.

Root canal treatment in Skopje: why Dr. Milanovski?

‘Save the tooth’ is the practice’s motto: keeping your natural teeth comes first. If a tooth genuinely cannot be saved, we will tell you openly.

• The practice carries out first-time root canal treatment and retreatment, and treats infected roots where the nerve has died.
• A weakened tooth can be rebuilt with a titanium post and a metal-ceramic (porcelain bonded to metal) crown.
• Dr Kiril Milanovski explains each step and all your options before treatment.
• The practice has a contract with the Fund, so if you are insured, you can register with Dr Kiril Milanovski as your chosen dentist.

Our article Save the tooth separates root canal myths from facts.

Root canal treatment: frequently asked questions

If you have toothache or want to know whether a tooth can be saved, book an examination. Afterwards, you will know your options.